Based on the above findings, the analgesic effects of LLLT were found to be valid. The serum PGE(2) levels are therefore considered to directly reflect nociceptive pain.
The distribution of neural elements in the triangular fibrocartilage complex (TFCC) of the human wrists was studied via immunohistochemical staining of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Articular branches projecting to the TFCC arose from the dorsal branch of the ulnar nerve in all wrists examined. The TFCC is subdivided into the following six regions: the articular disc proper (ADP), meniscus homolog (MH), radio-ulnar ligament (RUL), loose part of ulnar collateral ligament (lUCL), dense part of ulnar collateral ligament (dUCL), and internal portion (IP). The IP consists of a mixture of dense and loose connective tissues enclosed by the ADP, MH, RUL, and UCL, and resides deep in the prestyloid recess, which is a pit in the MH. The densities of PGP 9.5-positive neural elements, including free nerve endings, single nerve fibers, nerve fascicles, and perivascular neural nets, were significantly higher in the IP than in other regions. Some of the neural elements except for the perivascular neural nets were positive for CGRP. The high density of neural elements in the IP suggests that sensory nerves projecting to the TFCC enter into the IP and from there distribute to adjacent regions such as the MH and RUL. Free nerve endings are responsible for pain transmission. The high density of free nerve endings in the IP suggests that the IP is a source of ulnar side wrist pain.
Ⅲ ABSTRACTA new procedure for unstable fractures of the distal radius is presented. It uses a nonbridging external fixator in conjunction with calcium phosphate bone cement through a limited exposure. The best indication for the new procedure is intra-articular fracture with some large displaced fragments in young adults. In the C2 or C3 type fractures according to AO classification, it is very difficult to obtain satisfactory fixation with a plate and screws due to comminution of the articular surface and metaphysical bone defects in many instances. After reduction of the articular surface, this new technique allows fixation of the comminuted fragments using half pins of a nonbridging external fixator. Furthermore, injection of calcium phosphate bone to the bone defect helps to make both the articular surface and the cortical bone stable. The nonbridging external fixator allows early exercises. However, it cannot be applied to all types of the fracture because of its structural limitations. The combination of nonbridging external fixation and calcium phosphate bone applications assures early exercise of the wrist.
We document a case of bilateral ulnar nerve palsy that developed in an 27-year-old Japanese man who had bilateral hypoplasia of the humeral trochlea. Surgical management produced good results regarding the ulnar nerve palsy. The pathogenesis of the nerve paresis in this particular condition is discussed. There have been no reports outside Japan. Whether this deformity occurs only in persons of Japanese extraction or is simply overlooked by foreign surgeons is an interesting question.
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